Provider Demographics
NPI:1558363382
Name:PUMO, JEROME JR (DO,FACOFP)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:PUMO
Suffix:JR
Gender:M
Credentials:DO,FACOFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 KLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-1925
Mailing Address - Country:US
Mailing Address - Phone:732-574-1777
Mailing Address - Fax:732-574-2707
Practice Address - Street 1:132 WESTFIELD AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2453
Practice Address - Country:US
Practice Address - Phone:732-574-1777
Practice Address - Fax:732-574-2707
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02746100207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJUP094OtherOXFORD
NJ2237789OtherAETNA
NJ106094Medicare ID - Type UnspecifiedPROVIDER ID NUMBER